Technology Reducing the Risk of Retained Surgical Instruments

February 16, 2012 - The scenario is one of a patient’s worst nightmares: They go into the hospital for surgery and leave with a lot more than they bargained for--a foreign object left inside the surgical site. Left unnoticed, it could result in numerous medical complications, including infection, bowel perforation, abscess, undue pain, return to surgery and even death.

“It is estimated that 1,500 to 2,000 retained surgical item (RSI) incidents--where an object like a sponge or gauze is left inside a patient after a surgical procedure--occur each year in the United States. It is a dangerous, and often very costly, medical error,” explained Jeffrey Port, M.D., associate professor of cardiothoracic surgery and associate attending surgeon in the division of thoracic surgery at New York Presbyterian-Weill Cornell Medical Center in New York City.

“According to The Joint Commission, objects accidentally left inside a patient during surgery is among the top 10 sentinel events reported,” Port continued. “The number of RSIs nearly doubled in 2010 compared with 2008.”

With The Joint Commission’s continued focus on patient safety and the investigation of sentinel events, as well as payers’ denial of reimbursement for hospital-acquired conditions, prevention of RSIs has become even more critical. New technology has been developed to enhance clinicians’ ability to mitigate the risk of surgical instrument retention and protect patient safety.

“Combining standardized counting procedures with technology and improving communication are key processes for prevention of RSI,” explained Lisa Spruce, RN, DNP, director, evidence-based perioperative practice, with the Association of periOperative Nurses (AORN). “We have been using radiological verification for years to detect radiopaque soft goods and instruments. Today we have radiofrequency detection technology that can detect radiofrequency-tagged material that is used inside the patient. When a patient is scanned using this technology it will alert the surgical team that an item has remained inside the patient.”

One such technology is the RF Assure Detection System, developed by Bellevue, Washington-based RF Surgical Systems, Inc., which Port founded.

The RF Assure Detection System features an automatic detection mat for “hands-free” patient scanning that can speed up searches and verify a nurse's count of surgical items.

“The RF Assure Detection System helps to eliminate the risk of an RSI by serving as an added verification and security for manual counting of surgical materials by OR staff,” Port explained. “The surgical count is an important process in the OR, but it’s one that can sometimes be compromised by distraction, multitasking, time limitations and human error--especially in bariatric, cardiac or trauma cases where risk for RSIs is higher.”

RF Assure works by placing a detection mat under a patient on the surgical table. Once surgery is complete--and prior to closure of the incision site--a wand is held over the patient to conduct a scan of the site and either verify the nurses’ count or alert them where an RSI is located, saving them time searching for the object.

“RF Assure provides the ability to verify a surgical sponge count quickly, with the push of a button,” he continued. “This improves efficiency and provides OR staff confidence that no objects are left behind. Furthermore, early detection of missing surgical items may also reduce the need for unnecessary X-rays and associated anesthesia time to locate any missing materials.”

While the evolution of new technology to prevent RSIs is undoubtedly beneficial, the important role of the nurse in advocating for patient safety in an OR setting cannot be denied. Nurses, who are responsible for ensuring that all surgical materials are accounted for after surgery, are critical eyes in any OR environment.

“Our first and foremost concern is the safety of the patient. Nurses are the voice of the patient and our role is to ensure that every item that is used inside the patient’s body during surgery is accounted for,” concluded Spruce. “The OR nurse follows and assures the team’s strict adherence to AORN’s Recommended Practices for Retained Surgical Items, organizational policy and procedure, and standardized processes for counting. The nurse is responsible to speak up if a situation arises that might threaten the safety of the patient.”

This month, AORN released the Implementation Guide for the “Recommended Practices for the Prevention of Retained Surgical Items.” This can be found in the February issue of the AORN Journal; it provides real-life scenarios that bridge the gap between AORN standards and their implementation. For more information, visit the AORN website.